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Medina-Aedo M, Beltran J, Valli C, Canelo-Aybar C, Song Y, Ballester M, Bowman-Busato J, Christogiannis C, Grammatikopoulou MG, Groene O, Heijmans M, Hoogendorn M, Killeen SL, Kontouli KM, Mavridis D, Miñambres I, Mueller BS, Niño de Guzman E, Noordman J, Orrego C, Perestelo-Perez L, Saz-Parkinson Z, Seitidis G, Suñol R, Tsokani S, Alonso-Coello P. Recommendations on self-management interventions for adults living with obesity: COMPAR-EU project. Clin Obes 2024; 14:e12667. [PMID: 38757917 DOI: 10.1111/cob.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/29/2024] [Accepted: 03/29/2024] [Indexed: 05/18/2024]
Abstract
Self-management interventions (SMIs) may improve disease management in adults living with obesity. We formulated evidence-based recommendations for SMIs within the context of the COMPAR-EU project. The multidisciplinary panel selected critical outcomes based on the COMPAR-EU core outcome set and established decision thresholds for each outcome. Recommendations were informed by systematic reviews of effects, cost-effectiveness, and a contextual assessment. To assess the certainty of the evidence and formulate the recommendations, we used the GRADE approach guidance. Overall, SMIs were deemed to have a small impact, but the absence of harmful effects and potential cumulative benefits indicated a favourable balance of effects, despite low certainty. SMIs showed variations in structure, intensity, and resource utilisation, but overall are likely to be cost-effective. Adapting SMIs to local contexts would enhance equity, acceptability, and feasibility, considering patients' values, and availability of resources and teamwork. Consequently, the panel made conditional recommendations favouring SMIs over usual care. The rigorous and explicit recommendations demonstrated the effectiveness of SMIs for adults living with obesity. However, the gaps in the literature influenced the panel to make only conditional recommendations in favour of SMIs. Further research is needed to strengthen the evidence base and improve recommendations' certainty and applicability.
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Affiliation(s)
- Melixa Medina-Aedo
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Yang Song
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
| | | | - Christos Christogiannis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Maria G Grammatikopoulou
- Immunonutrition and Clinical Nutrition Unit, Department of Rheumatology and Clinical Immunology, Medical School, University of Thessaly, Biopolis Campus, Larissa, Greece
| | | | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Martine Hoogendorn
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Katerina-Maria Kontouli
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Inka Miñambres
- Endocrinology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Barcelona, Spain
| | - Beate Sigrid Mueller
- Institute of General Practice, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ena Niño de Guzman
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Janneke Noordman
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
| | - Lilisbeth Perestelo-Perez
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Canary Islands, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | | | - Georgios Seitidis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Fitzgerald I, Crowley EK, Ní Dhubhlaing C, O'Dwyer S, Sahm LJ. Informing the development of antipsychotic-induced weight gain management guidance: patient experiences and preferences - qualitative descriptive study. BJPsych Open 2024; 10:e136. [PMID: 39086041 DOI: 10.1192/bjo.2024.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Antipsychotic-induced weight gain (AIWG) is a substantial contributor to high obesity rates in psychiatry. Limited management guidance exists to inform clinical practice, and individuals with experience of managing AIWG have had no or minimal input into its development. A lack of empirical research outlining patient values and preferences for management also exists. Recommendations addressing weight management in psychiatry may be distinctly susceptible to ideology and sociocultural values regarding intervention appropriateness and expectations of self-management, reinforcing the need for co-produced management guidance. This study is the first to ask: how do individuals conceptualise preferred AIWG management and how can this be realised in practice? AIMS 1. Explore the management experiences of individuals with unwanted AIWG. 2. Elicit their values and preferences regarding preferred management. METHOD Qualitative descriptive methodology informed study design. A total of 17 participants took part in semi-structured interviews. Data analysis was undertaken using reflexive thematic analysis. RESULTS Participants reported that clinicians largely overestimated AIWG manageability using dietary and lifestyle changes. They also reported difficulties accessing alternative management interventions, including a change in antipsychotic and/or pharmacological adjuncts. Participants reported current management guidance is oversimplified, lacks the specificity and scope required, and endorses a 'one-size-fits-all' management approach to an extensively heterogenous side-effect. Participants expressed a preference for collaborative AIWG management and guidance that prioritises early intervention using the range of evidence-based management interventions, tailored according to AIWG risk, participant ability and participant preference. CONCLUSION Integration of this research into guideline development will help ensure recommendations are relevant and applicable, and that individual preferences are represented.
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Affiliation(s)
- Ita Fitzgerald
- Pharmacy Department, St Patrick's Mental Health Services, Dublin, Ireland; and Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Erin K Crowley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Ciara Ní Dhubhlaing
- Pharmacy Department, St Patrick's Mental Health Services, Dublin, Ireland; and College of Mental Health Pharmacy, Burgess Hill, UK
| | - Sarah O'Dwyer
- Department of Medicine, St Patrick's Mental Health Services, Dublin, Ireland
| | - Laura J Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland; and Pharmacy Department, Mercy University Hospital, Cork, Ireland
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Kaplan LM, Apovian CM, Ard JD, Allison DB, Aronne LJ, Batterham RL, Busetto L, Dicker D, Horn DB, Kelly AS, Mechanick JI, Purnell JQ, Ramos‐Salas X. Assessing the state of obesity care: Quality, access, guidelines, and standards. Obes Sci Pract 2024; 10:e765. [PMID: 39026558 PMCID: PMC11255038 DOI: 10.1002/osp4.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 07/20/2024] Open
Abstract
Background An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence. Aims The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity. Methods The panel was held in Leesburg, Virginia in September 2019. Results The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice guidelines (CPG) to better reflect obesity's pathophysiological basis and heterogeneity, as well as the disease's health, sociocultural, and economic complications; effects on quality of life; need for standards for quantitative comparison of treatment benefits, risks, and costs; and the need to more effectively integrate obesity treatment guidelines into routine clinical practice and to facilitate more direct clinician participation to improve public understanding of obesity as a disease with a pathophysiological basis. The panel also recommended that professional organizations working to improve the care of people with obesity collaborate via a working group to develop an updated, patient-focused, comprehensive CPG establishing standards of care, addressing identified needs, and providing for routine, periodic review and updating. Conclusions Unmet needs in the definition, assessment and treatment of obesity were identified and a blueprint to address these needs developed via a clinical practice guideline that can be utilized worldwide to respond to the increasing prevalence of obesity.
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Affiliation(s)
- Lee M. Kaplan
- Obesity, Metabolism and Nutrition InstituteMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Caroline M. Apovian
- Division of Endocrinology, Diabetes, Nutrition and Weight ManagementNutrition and Weight Management CenterBoston Medical Center and Boston University School of MedicineBostonMassachusettsUSA
| | - Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - David B. Allison
- Department of Epidemiology and BiostatisticsIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Louis J. Aronne
- Department of MedicineWeill‐Cornell College of MedicineNew YorkNew YorkUSA
| | - Rachel L. Batterham
- Department of MedicineCentre for Obesity ResearchRayne InstituteUniversity College LondonLondonUK
- National Institute for Health and Care ResearchUniversity College London Hospitals Biomedical Research CentreLondonUK
| | - Luca Busetto
- Department of MedicineUniversity of PadovaPadovaItaly
| | - Dror Dicker
- Department of Internal Medicine DHaharon Hospital Rabin Medical CenterSackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Deborah B. Horn
- Center for Obesity Medicine and Metabolic PerformanceUniversity of Texas McGovern Medical SchoolHoustonTexasUSA
| | - Aaron S. Kelly
- Department of Pediatrics and Center for Pediatric Obesity MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jeffrey I. Mechanick
- Marie‐Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai HeartNew YorkNew YorkUSA
- Metabolic SupportDivision of Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jonathan Q. Purnell
- Division of Endocrinology, Diabetes, and Clinical NutritionKnight Cardiovascular InstituteOregon Health & Science UniversityPortlandOregonUSA
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Ryan L, Quigley F, Birney S, Crotty M, Conlan O, Walsh JC. 'Beyond the Scale': A Qualitative Exploration of the Impact of Weight Stigma Experienced by Patients With Obesity in General Practice. Health Expect 2024; 27:e14098. [PMID: 38859797 PMCID: PMC11165259 DOI: 10.1111/hex.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE Obesity is a complex, chronic, relapsing disease that requires an individualised approach to treatment. However, weight stigma (WS) experienced in healthcare settings poses a significant barrier to achieving person-centred care for obesity. Understanding the experiences of people living with obesity (PwO) can inform interventions to reduce WS and optimise patient outcomes. This study explores how patients with obesity perceive WS in general practice settings; its impact on their psychological well-being and health behaviours, and the patients suggestions for mitigating it. METHODS In-depth semistructured interviews were conducted with 11 PwO who had experienced WS in general practice settings in Ireland. The interviews were conducted online via Zoom between May and August 2023; interviews lasted between 31 and 63 min (M = 34.36 min). Interviews were audio-recorded, transcribed verbatim and analysed using inductive reflexive thematic analysis. RESULTS Three overarching themes specific to participants' experience of WS in general practice were generated: (1) shame, blame and 'failure'; (2) eat less, move more-the go-to treatment; (3) worthiness tied to compliance. A fourth theme: (4) the desire for a considered approach, outlines the participants' suggestions for reducing WS by improving the quality of patient-provider interactions in general practice. CONCLUSION The findings call for a paradigm shift in the management of obesity in general practice: emphasising training for GPs in weight-sensitive communication and promoting respectful, collaborative, and individualised care to reduce WS and improve outcomes for people with obesity. PATIENT OR PUBLIC CONTRIBUTION PPI collaborators played an active and equal role in shaping the research, contributing to the development of the research questions, refining the interview schedule, identifying key themes in the data, and granting final approval to the submitted and published version of the study.
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Affiliation(s)
- Leona Ryan
- School of PsychologyUniversity of GalwayGalwayIreland
| | - Fiona Quigley
- School of Communication and MediaUlster UniversityBelfastNorthern Ireland
| | - Susie Birney
- Irish Coalition for People Living with Obesity (ICPO)DublinIreland
| | | | - Owen Conlan
- School of Computer Science and StatisticsTrinity College DublinDublinIreland
| | - Jane C. Walsh
- School of PsychologyUniversity of GalwayGalwayIreland
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Donovan CM, McNulty B. Living with obesity in Ireland: determinants, policy and future perspectives. Proc Nutr Soc 2024; 83:82-94. [PMID: 38047397 DOI: 10.1017/s0029665123004780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Globally, the prevalence of those living with obesity (≥30 kg/m2) is rising, with this trend expected to continue if firm and decisive policy interventions are not introduced. Across Europe, despite many consecutive policies aiming to reverse rising trends in weight status over recent decades, no country is currently on track to halt and reverse current trends in the coming years. This is evident in Ireland too, whereby the reporting of nationally representative weight status data show that targets have not been achieved since reporting began. The aim of this review is to critically appraise recent evidence relating to the key determinants of obesity including weight status, diet quality and physical activity with an emphasis on socioeconomic inequalities. And to consider these in the context of respective policy measures and propose future-focused recommendations. Furthermore, as with the complex nature of obesity, multifaceted approaches that shift the focus from the individual and place responsibility at a societal level will be reviewed.
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Affiliation(s)
- C M Donovan
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - B McNulty
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Belfield, Dublin 4, Ireland
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Wiśniewska-Ślepaczuk K, Żak-Kowalska K, Moskal A, Kowalski S, Al-Wathinani AM, Alhajlah M, Goniewicz K, Goniewicz M. Nutritional Profiles and Their Links to Insulin Resistance and Anthropometric Variables in a Female Cohort. Metabolites 2024; 14:252. [PMID: 38786729 PMCID: PMC11122850 DOI: 10.3390/metabo14050252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
This study investigates the relationship between dietary habits and metabolic health among women, emphasizing the role of anthropometric parameters as proxies for insulin resistance. We analyzed data from 443 women categorized into two groups based on the presence or absence of clinically diagnosed insulin resistance. Our assessments included dietary quality, socio-demographic characteristics, and a series of anthropometric measurements such as body weight, Body Mass Index (BMI), Waist-Hip Ratio (WHR), Abdominal Volume Index (AVI), and Body Adiposity Index (BAI). The results indicated significant disparities in these parameters, with the insulin-resistant group exhibiting higher average body weight (78.92 kg vs. 65.04 kg, p < 0.001), BMI (28.45 kg/m2 vs. 23.17 kg/m2, p < 0.001), and other related measures, suggesting a strong influence of dietary patterns on body composition and metabolic risk. The study underscores the importance of dietary management in addressing insulin resistance, advocating for personalized dietary strategies to improve metabolic health outcomes in women. This approach highlights the need for integrating dietary changes with lifestyle modifications and socio-demographic considerations to combat metabolic risks effectively.
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Affiliation(s)
| | - Karolina Żak-Kowalska
- New Medical Techniques Specialist Hospital of the Holy Family, 36-060 Rudna Mała, Poland;
| | - Adrian Moskal
- Hospital Emergency Department, Voivodship Hospital in Krosno, 38-400 Krosno, Poland;
| | - Sebastian Kowalski
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Ahmed M. Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mousa Alhajlah
- Applied of Computer Science College, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, 08-521 Deblin, Poland;
| | - Mariusz Goniewicz
- Department of Emergency Medicine, Medical University of Lublin, 20-081 Lublin, Poland;
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Maher S, McHugh J, Crotty M, Birney S, O'Connell J, Finucane F, Spooner M. How do people living with obesity who use obesity services perceive healthcare professionals' representation of the disease on social media? An interpretative phenomenological analysis. BMJ Open 2024; 14:e081066. [PMID: 38626981 PMCID: PMC11029444 DOI: 10.1136/bmjopen-2023-081066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/28/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The objective of this study was to explore how people living with obesity who use obesity services perceive healthcare professionals' (HCPs) online representation of the disease on social media. By exploring their perspective, we aimed to develop a framework to inform good practice around social media use for HCPs. DESIGN This was a qualitative study using a phenomenological framework. Following in-depth semi-structured interviews, analysis was undertaken to identify superordinate themes relating to how HCPs portray living with obesity online. SETTING Patient advocacy organisation (The Irish Coalition for People Living with Obesity) and three clinical sites offering obesity treatment in Ireland. PARTICIPANTS 15 adult participants comprising of 12 women and 3 men who use social media and are living with obesity and who use obesity services. RESULTS Three key themes of how people living with obesity who use obesity services perceive HCP's online representation of the disease. (1) Negative experiences of HCPs-participants describe encountering weight stigma and bias on social media from HCPs that they characterised as simplistic and outdated conceptualisations. These engender shame, fear and anger. (2) Positive experience of HCPs-participants report social media allows HCPs to educate and inform public perception of obesity. Positive online experiences lead to feelings of inclusion, understanding and encouragement. (3) Expectations of HCPs-qualifications, professional titles and academic association affected the perceived trustworthiness of information and its impact on readers. Participants feel there is a duty of care for HCPs in obesity medicine to advocate and be active online to provide accurate medical information. CONCLUSION HCP's use of social media has a powerful impact on people with obesity who use healthcare and obesity services. Social media is a key tool in obesity awareness and education. We propose the '3E' framework-Empower, Evidence-Based and Educate and be educated to guide HCPs' social media use.
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Affiliation(s)
- Sean Maher
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph McHugh
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Susie Birney
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Jean O'Connell
- St Columcille's Hospital, Loughlinstown, Dublin, Ireland
| | - Francis Finucane
- HRB Clinical Research Facility, Galway University Hospitals, Galway, Ireland
- CURAM, Galway, Ireland
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Anastasiadou D, Herrero P, Garcia-Royo P, Vázquez-De Sebastián J, Slater M, Spanlang B, Álvarez de la Campa E, Ciudin A, Comas M, Ramos-Quiroga JA, Lusilla-Palacios P. Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial. J Med Internet Res 2024; 26:e51558. [PMID: 38578667 PMCID: PMC11031704 DOI: 10.2196/51558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. OBJECTIVE This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. METHODS A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. RESULTS Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89). CONCLUSIONS This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Pol Herrero
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Paula Garcia-Royo
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Julia Vázquez-De Sebastián
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d'Hebron Research Institute & Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Mel Slater
- Virtual Bodyworks S.L., Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Andreea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Comas
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- Psychiatry Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Pilar Lusilla-Palacios
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- Psychiatry Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
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Laville M, Robert M, Segrestin B. Barriers to metabolic surgery and how to address them. Metabolism 2024; 152:155764. [PMID: 38135182 DOI: 10.1016/j.metabol.2023.155764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023]
Abstract
After bariatric surgery, patients with obesity achieve sustainable weight loss, gain in mobility, quality of life and life expectancy. Bariatric surgery can lead to remission of type 2 diabetes or to long term glycaemic control for patients with type 2 diabetes, while medical treatment has a preventive efficacy on micro and macrovascular complications. This has led to the concept of metabolic surgery to treat type 2 diabetes. Despite the benefits, only a small proportion of eligible patients undergo bariatric/metabolic surgery. Powerful antidiabetic medications, self-estimated lack of knowledge by medical professionals and fear of surgical complications are some of the arguments to prefer medical treatment of type 2 diabetes obesity versus metabolic surgery. We have reviewed in this paper the barriers which explain the low referral rate to metabolic surgery. With the point of view of the diabetologist, the general practitioner and the patient, we have addressed them to help clinicians and patients model an evidenced-based patient-oriented medical plan.
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Affiliation(s)
- Martine Laville
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France; Department of Endocrinology, Diabetes and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré de L'Obésité de Lyon, Hospices Civils de Lyon, Pierre Bénite, France
| | - Maud Robert
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France; Department of Digestive Surgery, Center of Bariatric Surgery, Hospital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré de L'Obésité de Lyon, Hospices Civils de Lyon, Pierre Bénite, France
| | - Bérénice Segrestin
- CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France; Department of Endocrinology, Diabetes and Nutrition, Hôpital Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; Fédération Hospitalo-Universitaire DOIT, Centre Intégré de L'Obésité de Lyon, Hospices Civils de Lyon, Pierre Bénite, France.
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10
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Nowicka P, Sjögren L, Bertilsson AS, Järvholm K, Sellberg F, Sundbom M, Thalén L, Lagerros YT. Systematic Development of National Guidelines for Obesity Care: The Swedish Approach. Obes Facts 2024; 17:183-190. [PMID: 38253042 PMCID: PMC10987176 DOI: 10.1159/000536320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION With the rapid development of treatment modalities for obesity management, there is an increasing demand for guidance to facilitate the prioritization of interventions. In 2020, the Swedish National Board of Health and Welfare started the process of producing the first national guidelines for obesity care directed to decision makers who allocate resources to the best knowledge-based care. The main aim of this paper was to describe the systematic development of these guidelines, designed to guarantee uniformly high standards of care throughout the whole country. METHODS The standardized procedures of the National Board of Health and Welfare were applied to construct guidelines in a systematic and transparent way, including priority setting of recommendations and quality indicators to evaluate the progress of implementation. The process involved independent expert committees including professionals and patient representatives, and the guidelines were reviewed through an open public consultation. RESULTS National guidelines were issued in 2023, encompassing a broad scope, from identification and diagnosis to multiple treatment modalities, embedded in a life-course perspective from pregnancy to the elderly, as well as highlighting the need for improved knowledge and competence of health care providers. CONCLUSIONS National guidelines for improved standard care and evidence-based and efficient use of health care resources for obesity treatment can be developed in a systematic way with professionals and patient representatives.
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Affiliation(s)
- Paulina Nowicka
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Lovisa Sjögren
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Ann-Sofie Bertilsson
- Department for Analysis, The National Board of Health and Welfare, Stockholm, Sweden
| | - Kajsa Järvholm
- Department of Psychology, Lund University, Lund, Sweden
- Childhood Obesity Unit, Skåne University Hospital, Malmö, Sweden
| | - Fanny Sellberg
- National Guidelines and Screening, Department for Knowledge-Based Policy of Health Care, the National Board of Health and Welfare, Stockholm, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Surgery, University Hospital, Uppsala, Sweden
| | - Liv Thalén
- National Guidelines and Screening, Department for Knowledge-Based Policy of Health Care, the National Board of Health and Welfare, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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11
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Abraham Roshan J, Nagpal TS, Pearce N, Dhaliwal KK, El-Hussein M, Forhan M, Hadjiyanakis S, Hawa R, Kushner RF, Lee-Baggley D, McMillan M, Nutter S, Piccinini-Vallis H, Vallis M, Wharton S, Wiljer D, Sockalingam S. Transforming the landscape of obesity education - The Canadian obesity education competencies. OBESITY PILLARS 2023; 8:100091. [PMID: 38125661 PMCID: PMC10728696 DOI: 10.1016/j.obpill.2023.100091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023]
Abstract
Background With ongoing gaps in obesity education delivery for health professions in Canada and around the world, a transformative shift is needed to address and mitigate weight bias and stigma, and foster evidence-based approaches to obesity assessment and care in the clinical setting. Obesity Canada has created evidence-based obesity competencies for medical education that can guide curriculum development, assessment and evaluation and be applied to health professionals' education programs in Canada and across the world. Methods The Obesity Canada Education Action Team has seventeen members in health professions education and research along with students and patient experts. Through an iterative group consensus process using four guiding principles, key and enabling obesity competencies were created using the 2015 CanMEDS competency framework as its foundation. These principles included the representation of all CanMEDS Roles throughout the competencies, minimizing duplication with the original CanMEDS competencies, ensuring obesity focused content was informed by the 2020 Adult Obesity Clinical Practice Guidelines and the 2019 US Obesity Medication Education Collaborative Competencies, and emphasizing patient-focused language throughout. Results A total of thirteen key competencies and thirty-seven enabling competencies make up the Canadian Obesity Education Competencies (COECs). Conclusion The COECs embed evidence-based approaches to obesity care into one of the most widely used competency-based frameworks in the world, CanMEDS. Crucially, these competencies outline how to address and mitigate the damaging effects of weight bias and stigma in educational and clinical settings. Next steps include the creation of milestones and nested Entrustable Professional Activities, a national report card on obesity education for undergraduate medical education in Canada, and Free Open Access Medication Education content, including podcasts and infographics, for easier adoption into curriculum around the world and across the health professions spectrum.
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Affiliation(s)
| | - Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Mohamed El-Hussein
- Faculty of Health, Community & Education, School of Nursing and Midwifery, Mount Royal University, Calgary, Alberta, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stasia Hadjiyanakis
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert F. Kushner
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dayna Lee-Baggley
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, British Columbia, Canada
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sean Wharton
- University of Toronto, Wharton Medical Clinic, Toronto, Ontario, Canada
| | - David Wiljer
- University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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12
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Ramos Salas X, Saquimux Contreras MA, Breen C, Preiss Y, Hussey B, Forhan M, Wharton S, Campbell-Scherer D, Vallis M, Brown J, Pedersen SD, Sharma AM, Woodward E, Patton I, Pearce N. Review of an international pilot project to adapt the Canadian Adult Obesity Clinical Practice Guideline. OBESITY PILLARS (ONLINE) 2023; 8:100090. [PMID: 38125658 PMCID: PMC10728699 DOI: 10.1016/j.obpill.2023.100090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 12/23/2023]
Abstract
Background The evidence-based Canadian Adult Obesity Clinical Practice Guideline (CPG) released in August 2020 were developed through a systematic literature review and patient-oriented research process. This CPG is considered a paradigm shift for obesity care as it introduced a new obesity definition that is based on health not body size, incorporates lived experiences of people affected by obesity, and addresses the pervasive weight bias and stigma that patients face in healthcare systems. The purpose of this pilot project was to assess the feasibility of adapting the Canadian CPG in Chile and Ireland. Methods An International Clinical Practice Guideline Adaptation Committee was established to oversee the project. The project was conducted through four interrelated phases: 1) planning and preparation; 2) pilot project application process; 3) adaptation; and 4) launch, dissemination, and implementation. Ireland used the GRADE-ADAPTE framework and Chile used the GRADE-ADOLOPMENT approach. Results Chile and Ireland developed their adapted guidelines in one third of the time it took to develop the Canadian guidelines. In Ireland, 18 chapters, which underpin the 80 key recommendations, were contextually adapted. Chile adopted 18 chapters and 76 recommendations, adapted one recommendation, and developed 12 new recommendations.
. Conclusion The pilot project demonstrated it is feasible to adapt the Canadian CPG for use in other countries with different healthcare systems, languages, and cultural contexts, while retaining the Canadian CPG's key principles and values such as the treatment of obesity as a chronic disease, adoption of new clinical assessment approaches that go beyond anthropometric measurements, elimination of weight bias and stigma, shifting obesity care outcomes to improved health and well-being rather than weight loss alone, and the use of patient-centred, collaborative and shared-decision clinical care approaches.
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Affiliation(s)
| | - Miguel Alejandro Saquimux Contreras
- Universidade Estadual de Campinas - UNICAMP, Centro de Pesquisas em Saúde Reprodutiva de Campinas – CEMICAMP, Rua Vital Brasil, 200 Cidade Universitária, Campinas, SP, 13083-888, Brazil
| | - Cathy Breen
- Association for the Study of Obesity on the island of Ireland, Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Yudith Preiss
- Sociedad Chilena de Cirugía Bariátrica y Metabólica, Centro Medico Novamed, Lo Fontecilla 101, oficina 201-202, Las Condes, RM, Chile
| | - Brad Hussey
- Replica Communications, 156 Melville Street, Dundas, Ontario, L9H 2A8, Canada
| | - Mary Forhan
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160 – 500 University Ave., 9th floor, Toronto, ON, M5G 1V7, Canada
| | - Sean Wharton
- McMaster University, Wharton Medical Clinic, 2951 Walkers Line, Burlington, Ontario, L7M 4Y1, Canada
| | - Denise Campbell-Scherer
- University of Alberta, 2-590B Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada
| | - Michael Vallis
- Dalhousie University Family Medicine, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Jennifer Brown
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Sue D. Pedersen
- C-ENDO Diabetes and Endocrinology Clinic, Rockyview Health Centre II, Suite 210, 1016-68 Avenue SW, Calgary, Alberta, T2V 4J2, Canada
| | - Arya M. Sharma
- University of Alberta, Faculty of Medicine & Dentistry, 2J2.00 Walter C Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, Alberta, T6G 2R7, Canada
| | - Euan Woodward
- European Association for the Study of Obesity, Level 2, 8 Waldergrave Road, Teddington, Middlesex, TW11 8GT, United Kingdom
| | - Ian Patton
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
| | - Nicole Pearce
- Obesity Canada, 2-126 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, T6G 2E1, Canada
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13
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Felsenreich DM, Malzner A, Eichner M, Hoelbing E, Moosbrugger A, Beckerhinn P, Prager G, Brix JM, Itariu BK. [Indications and preoperative planning for bariatric surgery]. Wien Klin Wochenschr 2023; 135:721-728. [PMID: 37821695 PMCID: PMC10567874 DOI: 10.1007/s00508-023-02271-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
These clinical practice guidelines represent the consensus opinion of a group of Austrian specialist physicians associated with the treatment of obesity. The recommendations incorporate the current literature and guidelines and aim to balance both procedural feasibility and patient acceptance and adherence. Special emphasis was placed on simplification of the preoperative clarification and maximum patient safety. Therefore, this article makes no claim to be complete in all fields.
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Affiliation(s)
- Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Andrea Malzner
- Abteilung für Innere Medizin I, Gastroenterologie und Hepatologie, Rheumatologie, Endokrinologie und Diabetologie, Klinikum Wels-Grieskirchen, Wels, Österreich
| | - Marlies Eichner
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | | | - Alexander Moosbrugger
- Abteilung für Innere Medizin II, Krankenhaus der Barmherzigen Brüder, Graz, Österreich
| | - Philipp Beckerhinn
- Abteilung für Chirurgie, Landesklinikum Hollabrunn, Hollabrunn, Österreich
| | - Gerhard Prager
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
- Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Bianca-Karla Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
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14
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Brix JM, Andersen B, Aydinkoc-Tuzcu K, Beckerhinn P, Brossard-Eitzinger A, Cavini A, Ciardi C, Clodi M, Eichner M, Erlacher B, Fahrnberger M, Felsenreich DM, Francesconi C, Göbel B, Hölbing E, Hoppichler F, Huber J, Huber SL, Itariu BK, Jandrasitz B, Kiefer FW, Köhler G, Kruschitz R, Ludvik B, Malzner A, Moosbrugger A, Öfferlbauer-Ernst A, Parzer V, Prager G, Resl M, Ress C, Schelkshorn C, Scherer T, Sourji H, Stechemesser L, Stulnig T, Toplak H, Wakolbinger M, Vonbank A, Weghuber D. [Overweight and obesity in adults: general principles of treatment and conservative management]. Wien Klin Wochenschr 2023; 135:706-720. [PMID: 37821694 PMCID: PMC10567802 DOI: 10.1007/s00508-023-02270-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 10/13/2023]
Abstract
The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by a multidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for a structured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.
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Affiliation(s)
- Johanna Maria Brix
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | | | - Kadriye Aydinkoc-Tuzcu
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Philipp Beckerhinn
- Abteilung für Chirurgie, Landesklinikum Hollabrunn, Hollabrunn, Österreich
| | - Agnes Brossard-Eitzinger
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Anna Cavini
- kokon – Reha für junge Menschen, Bad Erlach, Österreich
| | - Christian Ciardi
- Abteilung für Innere Medizin, Krankenhaus St. Vinzenz Zams, Zams, Österreich
| | - Martin Clodi
- ICMR – Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Marlies Eichner
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Brigitte Erlacher
- Abteilung Innere Medizin III, Krankenhaus Barmherzige Schwestern, Wien, Österreich
| | | | - Daniel Moritz Felsenreich
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | | | - Bettina Göbel
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
| | - Elisabeth Hölbing
- Landeskrankenhaus Hochsteiermark, Standort Leoben, Leoben, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
- Institut SIPCAN – Initiative für ein gesundes Leben, Salzburg, Österreich
| | - Joakim Huber
- Interne Abteilung mit Akutgeriatrie und Palliativmedizin, Franziskus Spital, Standort Landstraße, Wien, Österreich
| | - Simone Leonora Huber
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Bianca Karla Itariu
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Birgit Jandrasitz
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Florian W. Kiefer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Gerd Köhler
- Rehabilitationszentrum Aflenz für Stoffwechselerkrankungen mit Schwerpunkt Diabetes mellitus und hochgradige Adipositas, Aflenz, Österreich
| | - Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen Klagenfurt, Klagenfurt, Österreich
| | - Bernhard Ludvik
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Andrea Malzner
- Abteilung für Innere Medizin I, Klinikum Wels Grieskirchen, Standort Wels, Wels, Österreich
| | - Alexander Moosbrugger
- Abteilung für Innere Medizin II, Konventhospital der Barmherzigen Brüder Graz-Marschallgasse, Graz, Österreich
| | - Anna Öfferlbauer-Ernst
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Verena Parzer
- 1. Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Karl Landsteiner Institut für Adipositas und Stoffwechselerkrankungen, Klinik Landstraße, Wien, Österreich
| | - Gerhard Prager
- Klinische Abteilung für Viszeralchirurgie, Universitätsklinik für Allgemeinchirurgie, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- ICMR – Institute for Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Linz, Österreich
- Abteilung für Innere Medizin mit Diabetologie, Gastroenterologie und Hepatologie, Rheumatologie und Intensivmedizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Claudia Ress
- Department für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | | | - Thomas Scherer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Harald Sourji
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, mit Gastroenterologie Hepatologie, Nephrologie, Stoffwechsel und Diabetologie, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Thomas Stulnig
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner-Institut für Stoffwechselerkrankungen und Nephrologie, Klinik Hietzing, Wien, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
| | - Maria Wakolbinger
- Abteilung für Sozial- und Präventivmedizin, Zentrum für Public Health, Medizinische Universität Wien, Wien, Österreich
| | - Alexander Vonbank
- Abteilung für Innere Medizin I, Akademisches Lehrkrankenhaus Feldkirch, Feldkirch, Österreich
| | - Daniel Weghuber
- Universitätsklinik für Kinder- und Jugendheilkunde, Uniklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
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15
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Finucane FM, Gibson I, Hughes R, Murphy E, Hynes L, Harris A, McGuire BE, Hynes M, Collins C, Cradock K, Seery S, Jones J, O’Brien T, O’Donnell MJ. Factors associated with weight loss and health gains in a structured lifestyle modification programme for adults with severe obesity: a prospective cohort study. Front Endocrinol (Lausanne) 2023; 14:1257061. [PMID: 37916153 PMCID: PMC10616877 DOI: 10.3389/fendo.2023.1257061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023] Open
Abstract
Background Individual responses to behavioural weight loss interventions can vary significantly, and a better understanding of the factors associated with successful treatment might help to target interventions for those who will benefit the most. We sought to identify demographic and clinical characteristics that predicted intervention "success" (defined as ≥5% weight loss) and other health gains in patients with severe obesity attending a ten-week structured lifestyle modification programme. Methods We conducted a prospective cohort study of all 1122 patients (751 (66.9%) female, mean age 47.3 ± 11.9 years, mean body mass index (BMI) 46.7 ± 7.8 kgm-2) referred from our hospital-based obesity clinic, who started the structured lifestyle programme between 2012-2019. We compared routine clinical measures such as weight, fitness, blood pressure, lipids and HbA1c at baseline and follow-up. We also used validated questionnaires to quantify anxiety, depression and health-related quality of life. Results Of 1122 patients who started, 877 (78.2%) completed the programme and attended for follow up. Of these, 12.8% lost ≥5% body weight. The amount of weight lost was a strong and consistent predictor of improvements in metabolic, cardiovascular, and mental health, even after adjusting for age, sex, programme attendance and baseline fitness. Older age, male sex, being physically active and having lower anxiety and depression scores at baseline predicted greater weight loss. Younger age, depression and longer wait time to start the intervention were associated with drop-out. Conclusions In adults with severe obesity completing a structured lifestyle modification programme, older age and good mental health were associated with programme completion and attaining ≥5% weight loss. The magnitude of weight lost was a strong predictor of improvements in cardiovascular, metabolic and mental health associated with programme completion.
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Affiliation(s)
- Francis M. Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Irene Gibson
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Robert Hughes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Enda Murphy
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Lisa Hynes
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Aisling Harris
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Brian E. McGuire
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- School of Psychology, University of Galway, Galway, Ireland
| | - Chris Collins
- Department of Upper Gastrointestinal Surgery, Galway University Hospital, Galway, Ireland
| | - Kevin Cradock
- Department of Health and Nutrition Sciences, Atlantic Technological University, Sligo, Ireland
| | - Suzanne Seery
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Jennifer Jones
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Croí, The West of Ireland Cardiac Foundation, Galway, Ireland
- National Institute of Preventive Cardiology, University of Galway, Galway, Ireland
| | - Tim O’Brien
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
| | - Martin J. O’Donnell
- Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Cúram, University of Galway, Galway, Ireland
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16
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Thanos PK, Hanna C, Mihalkovic A, Hoffman A, Posner A, Butsch J, Blum K, Georger L, Mastrandrea LD, Quattrin T. Genetic Correlates as a Predictor of Bariatric Surgery Outcomes after 1 Year. Biomedicines 2023; 11:2644. [PMID: 37893019 PMCID: PMC10603884 DOI: 10.3390/biomedicines11102644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
This study analyzed genetic risk assessments in patients undergoing bariatric surgery to serve as a predictive factor for weight loss parameters 1 year after the operation. Thirty (30) patients were assessed for Genetic Addiction Risk Severity (GARS), which analyzes neurogenetic polymorphisms involved in addiction and reward deficiency. Genetic and psychosocial data collected before the operation were correlated with weight loss data, including changes in weight, body mass index (BMI), and percent of expected weight loss (%EWL). Results examined correlations between individual gene risk alleles, 1-year body weight data, and psychosocial trait scores. Spearman's correlations revealed that the OPRM1 (rs1799971) gene polymorphism had significant negative correlation with 1-year weight (rs = -0.4477, p < 0.01) and BMI (rs = -0.4477, p < 0.05). In addition, the DRD2 risk allele (rs1800497) was correlated negatively with BMI at 1 year (rs = -0.4927, p < 0.05), indicating that one risk allele copy was associated with lower BMI. However, this allele was positively correlated with both ∆Weight (rs = 0.4077, p < 0.05) and %EWL (rs = 0.5521, p < 0.05) at 1 year post-surgery. Moreover, the overall GARS score was correlated with %EWL (rs = 0.4236, p < 0.05), ∆Weight (rs = 0.3971, p < 0.05) and ∆BMI (rs = 0.3778, p < 0.05). Lastly, Food Cravings Questionnaire (FCQ) scores were negatively correlated with %EWL (rs = -0.4320, p < 0.05) and ∆Weight at 1 year post-surgery (rs = -0.4294, p < 0.05). This suggests that individuals with a higher genetic addiction risk are more responsive to weight loss treatment, especially in the case of the DRD2 polymorphism. These results should translate clinically to improve positivity and attitude related to weight management by those individuals born with the risk alleles (rs1800497; rs1799971).
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Affiliation(s)
- Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
| | - Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
| | - Abrianna Mihalkovic
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Clinical Research Institute on Addictions, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, NY 14203, USA; (C.H.)
- Department of Psychology, University at Buffalo, Buffalo, NY 14203, USA
| | - Aaron Hoffman
- Department of Surgery, Methodist Hospital Medical Center, Dallas, TX 75208, USA
| | - Alan Posner
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - John Butsch
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Kenneth Blum
- Division of Nutrigenomics, SpliceGen, Therapeutics, Inc., Austin, TX 78701, USA;
- Department of Psychiatry, Wright State University Boonshoft School of Medicine and Dayton VA Medical Center, Dayton, OH 45435, USA
- Division of Addiction Research & Education, Center for Exercise Sports & Global Mental Health, Western University Health Sciences, Pomona, CA 91766, USA
- The Kenneth Blum Behavioral & Neurogenetic Institute, LLC., Austin, TX 78701, USA
- Institute of Psychology, ELTE Eötvös Loránd University, 1075 Budapest, Hungary
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur 721172, West Bengal, India
- Department of Molecular Biology, Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Lesley Georger
- Department of Natural Sciences and Mathematics, D’Youville University, Buffalo, NY 14201, USA;
| | - Lucy D. Mastrandrea
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA (T.Q.)
| | - Teresa Quattrin
- UBMD Pediatrics, JR Oishei Children’s Hospital, University at Buffalo, Buffalo, NY 14203, USA (T.Q.)
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17
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Samakidou GE, Koliaki CC, Liberopoulos EN, Katsilambros NL. Non-Classical Aspects of Obesity Pathogenesis and Their Relative Clinical Importance for Obesity Treatment. Healthcare (Basel) 2023; 11:healthcare11091310. [PMID: 37174852 PMCID: PMC10178220 DOI: 10.3390/healthcare11091310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
Obesity is a chronic disease and a major public health problem due to its association with non-communicable diseases and all-cause mortality. An increased energy intake and decreased physical activity have been long recognized as the classical parameters that contribute to the development of obesity. However, several other, non-classical factors have also been associated with obesity through various complex mechanisms. Some of them are diet related, such as diet quality, dietary habits and speed of eating. Other factors are non-dietary, such as endocrine-disrupting chemicals, sleep quality and quantity, psychotropic medications and light at night. The scope of the present narrative review is to address these non-classical factors that are implicated in the pathogenesis of obesity, to clarify their potential role in the management of obesity and, where possible, to provide some practical clinical recommendations.
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Affiliation(s)
- Georgia E Samakidou
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Chrysi C Koliaki
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Evangelos N Liberopoulos
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Nikolaos L Katsilambros
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
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